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Breast Cancer Treatment (PDQ)

GENERAL INFORMATION

• Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

• A family history of breast cancer and other factors increase the risk of breast cancer.

• Breast cancer is sometimes caused by inherited gene mutations (changes).

• The use of certain medicines and other factors decrease the risk of breast cancer.

• Signs of breast cancer include a lump or change in the breast.

• Tests that examine the breasts are used to detect (find) and diagnose breast cancer.

• If cancer is found, tests are done to study the cancer cells.

• Certain factors affect prognosis (chance of recovery) and treatment options.

STAGES OF BREAST CANCER

• After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.

• There are three ways that cancer spreads in the body:

1. Tissue. The cancer spreads from where it began by growing into nearby areas.
2. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
3. Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

• Cancer may spread from where it began to other parts of the body.

• The following stages are used for breast cancer:

Stage 0 (carcinoma in situ)

There are 3 types of breast carcinoma in situ: Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues. At this time, there is no way to know which lesions could become invasive.

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  Ductal carcinoma in situ (DCIS). Abnormal cells are found in the lining of a breast duct.

• Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in thelobules of the breast. This condition seldom becomes invasive cancer. Information about LCIS is not included in this summary.

  

  Lobular carcinoma in situ (LCIS). Abnormal cells are found in the lobules of the breast.

Paget disease of the nipple is a condition in which abnormal cells are found in the nipple only.



Stage I








Stage I breast cancer. In stage IA, the tumor is 2 centimeters or smaller and has not spread outside the breast. In stage IB, no tumor is found in the breast or the tumor is 2 centimeters or smaller. Small clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes.







In stage I, cancer has formed. Stage I is divided into stages IA and IB.

> In stage IA, the tumor is 2 centimeters or smaller. Cancer has not spread outside the breast.

> In stage IB, small clusters of breast cancer cells (larger than 0.2 millimeter but not larger     than 2 millimeters) are found in the lymph nodes and either:                     

*no tumor is found in the breast; or                   

*the tumor is 2 centimeters or smaller.














Stage II


Stage II is divided into stages IIA and IIB.

In stage IIA:                                                                                                                                                           no tumor is found in the breast or the tumor is 2 centimeters or smaller. Cancer(larger than 2 millimeters) is found in 1 to 3 axillary lymph nodes or in the lymph nodes near the breastbone (found during a sentinel lymph node biopsy); or the tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes.

• Stage IIA breast cancer. No tumor is found in the breast and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (left panel); OR the tumor is 2 centimeters or smaller and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (middle panel); OR the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the lymph nodes (right panel).

• In stage IIB, the tumor is:
  

  > larger than 2 centimeters but not larger than 5 centimeters. Small clusters of breast cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes; or larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy); or larger than 5 centimeters. Cancer has not spread to the lymph nodes. 

  

  Stage IIB breast cancer. The tumor is larger than 2 centimeters but not larger than 5 centimeters and small clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes (left panel); OR the tumor is larger than 2 centimeters but not larger than 5 centimeters and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (middle panel); OR the tumor is larger than 5 centimeters and has not spread to the lymph nodes (right panel).

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Stage IIIA
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  Stage IIIA breast cancer. No tumor is found in the breast or the tumor may be any size and cancer is found in 4 to 9 axillary lymph nodes or lymph nodes near the breastbone (left panel); OR the tumor is larger than 5 centimeters and small clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes (middle panel); OR the tumor is larger than 5 centimeters and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (right panel).

  
  

  In stage IIIA:

• > no tumor is found in the breast or the tumor may be any size. Cancer is found in 4 to 9 axillary lymph nodes or in the lymph nodes near the breastbone (found during imaging tests or a physical exam); or

• > the tumor is larger than 5 centimeters. Small clusters of breast cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes; or

• > the tumor is larger than 5 centimeters. Cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy).

Stage IIIB

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  Stage IIIB breast cancer. The tumor may be any size and cancer has spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. Cancer may have spread to up to 9 axillary lymph nodes or the lymph nodes near the breastbone. Cancer that has spread to the skin of the breast may be inflammatory breast cancer.

  
  

  In stage IIIB, the tumor may be any size and cancer has spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. Also, cancer may have spread to:

• *up to 9 axillary lymph nodes; or

• *the lymph nodes near the breastbone.

• Cancer that has spread to the skin of the breast may also be inflammatory breast cancer. See the section on Inflammatory Breast Cancer for more information.

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Stage IIIC

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  Stage IIIC breast cancer. No tumor is found in the breast or the tumor may be any size and may have spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. Also, cancer has spread to 10 or more axillary lymph nodes (left panel); OR to lymph nodes above or below the collarbone (middle panel); OR to axillary lymph nodes and lymph nodes near the breastbone (right panel). Cancer that has spread to the skin of the breast may be inflammatory breast cancer.

• In stage IIIC, no tumor is found in the breast or the tumor may be any size. Cancer may have spread to the skin of the breast and caused swelling or an ulcer and/or has spread to the chest wall. Also, cancer has spread to:

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• * 10 or more axillary lymph nodes; or

• * lymph nodes above or below the collarbone; or

• * axillary lymph nodes and lymph nodes near the breastbone.

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• Cancer that has spread to the skin of the breast may also be inflammatory breast cancer. See the section on Inflammatory Breast Cancer for more information.

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• For treatment, stage IIIC breast cancer is divided into operable and inoperable stage IIIC.

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Stage IV

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  Stage IV breast cancer. The cancer has spread to other parts of the body, most often the bones, lungs, liver, or brain.

  
  

  In stage IV, cancer has spread to other ogans of the body, most often the bones, lungs,liver, or brain.